“
test the safety and efficacy of this new formulation in young children

”

Bringing antiretroviral drugs to children

The CHAPAS trials have ensured that many more children with HIV have benefited
from life-saving antiretrovirals.

The challenge

TB control is undermined by the large number of likely cases that never undergo confirmatory testing or who are tested but do not start treatment. Globally, an estimated 40% of new cases are not reported to national TB control programmes. This leads to unnecessary mortality and morbidity, and also provides opportunities for the further spread of infection.

Uganda is a country with a high burden of TB, including multidrug-resistant TB. More than 40,000 cases are reported each year, only around half of which are started on treatment. Up to a third of patients are lost to follow up having started treatment.

In her Senior Fellowship, Dr Esther Buregyeya is exploring the patient’s perspective of TB care, with a view to identifying obstacles and enablers of health-seeking behaviour to improve linkage to care.

Dr Buregyeya has a particular interest in the use of behavioural interventions to improve health-seeking behaviour. There is some evidence that text messaging can improve adherence to treatment. In some circumstances, financial incentives may also be a way to overcome financial barriers to care seeking.

During her fellowship Dr Buregyeya is recruiting a cohort of individuals with suspected TB and tracking their pathway through testing and treatment. This will identify potential points of intervention to improve linkage to care. Through interviews and consultations with patients and other stakeholders, she plans to design an intervention strategy incorporating text messaging reminders and mobile money payments. These will be rooted in well-established theoretical frameworks for behavioural interventions, the ‘COM-B’ model. The interventions will then be evaluated (individually and in combination) in a controlled trial.

The project builds on Dr Buregyeya’s past work on TB patient pathways and delays. She also heads the Department of Disease Control and Environmental Health at Makerere University, and is spearheading the development of a master’s of public health and business administration, to promote greater consideration of public health within the business world. During her fellowship, she will train one PhD and three master’s students.

The project

The later CHAPAS-3 trial compared the efficacy and safety of three fixed-dose combinations including two without stavudine (found to have some long-term side effects in adults, leading to a recommendation that its use be discontinued in children). The trial the first of its kind in Africa studied nearly 500 children at four sites in two African countries.

Dr Buregyeya’s research will identify and evaluate contextually sensitive behavioural interventions, grounded in strong psychological theory, with the potential to increase retention of TB patients with the healthcare system in Uganda. This will ensure more patients receive the care they need and reduce opportunities for the spread of infection. The project will also generate rigorous evidence on interventions that could be adapted for use elsewhere in sub-Saharan Africa. The fellowship also provides an opportunity for Dr Buregyeya to develop her research leadership abilities, mentoring skills and ability to compete for funding.

ratios forfixed-dose combinations and on appropriatedosage according to weight. 

The CHAPAS-3 trial confirmed the effectiveness of fixed-dose combinations, providing further impetus to the rollout of antiretrovirals to children. Its evidence on abacavir informed the WHO recommendation of abacavir-containing combinations for first-line therapy in children. Trial data have also been used to support applications for regulatory approval for new scored efavirenz tablets.

Impact